2015年安徽省细菌耐药监测分析

Bacterial resistance surveillance in Anhui Province in 2015

目的了解安徽地区临床分布病原菌及其对常用抗菌药物的耐药情况,为临床用药提供依据。方法对2015年安徽地区31家医院参与细菌耐药监测送检临床分离的2 360株非重复菌株进行体外药敏实验,测定细菌的最低药物浓度(MIC),按CLSI2015年版判读药敏结果,采用WHONET5.6软件进行耐药性分析。结果安徽地区共临床分离病原菌2 360株,其中革兰阴性菌占82.4%(1 944/2 360),革兰阳性菌占17.6%(416/2 360)。葡萄球菌属中耐甲氧西林金黄色葡萄球菌(MRSA)、耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率为分别为64.7%和71.3%,未发现万古霉素、替考拉宁及利奈唑胺耐药菌株。屎肠球菌对常用抗生素的耐药率明显高于粪肠球菌,其中对万古霉素耐药率分别为5.4%和3.6%;革兰阴性菌中,前四位分离的菌株依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌,其中肠杆菌科细菌(1 365/1 944,57.8%),葡萄糖非发酵细菌(564/1 944,29.0%)。肠杆菌科细菌中,亚胺培南和美罗培南对肺炎克雷伯菌的耐药率(18.6%、17.8%)明显高于对大肠埃希菌的耐药率(8.7%、5.9%)。非发酵菌属中以铜绿假单胞菌和鲍曼不动杆菌多见,鲍曼不动杆菌对亚胺培南和美罗培南的耐药率高达80%以上,对头孢哌酮舒巴坦和阿米卡星耐药率均在50%以下。结论细菌耐药性严重,应加强对多重耐药菌的监测与防控,合理使用抗生素药物。

Objective To analyze the surveillance data on bacterial resistance in Anhui hospitals in 2015,to provide a reference for clinical medication. Methods Data on bacterial susceptibility testing of 2 360 clinical non-repeated isolates collected from 42 hospitals in Anhui Province were performed by vitro drug sensitivity test to determine MIC. The data were analyzed by using WHONET 5. 6 software according to CLSI（ 2015） guidelines. Results Among 2 360 clinical isolates,Gram negative organisms accounted for 82. 4%（ 1944 /2 360）,while gram positive organisms accounted for 17. 6%（ 416 /2 360）. The prevalence of methicillin-resistance strains among S. aureus and coagulase-negative isolates were 64. 7% and 71. 3% respectively. Staphylococcus isolates were 100% susceptible to vancomycin and linezolid. The resistance rate to the common antibiotics of the enterococcus faecium was significantly higher than that of the fecal strains,and the drug resistance rates were 5. 4%,3. 6% respectively. Among gram negative bacteria,the bacteria ranking the first four isolates were escherichia coli,klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii acinetobacter,including enterbacteriaceae（ 1 365 /1 944,57. 8%） and glucose non fermentation bacteria（ 564 /1 944,29. 0%）. Among enterobacteriaceae,resisitance rates of imipenem and meropenem to klebsiella pneumoniae（ 18. 6%,17. 8%） was significantly higher than that to escherichai coli（ 8. 7%,5. 9%）. In non fermenting bacteria,pseudomomas aeruginosa and acinetobacter baumanii were more common. The resistance rate of acinetobacter baumannii to imipenem and meropenem was as high as 80%,and the resistance rate to cefoperazone sulbactam and amikacin was below 50%. Conclusions Antibiotic resistance is serious in 2015,therefore,monitoring and preventive control should be strengthened on multi-drug resistant strains,so as to rationally choose antimicrobial agents in the treatment of bacterial infection.